Osseous Manifestations of Primary Hyperparathyroidism: Imaging Findings

Abstract

Primary hyperparathyroidism is a systemic endocrine disease that has significant effects on bone remodeling through the action of parathyroid hormone on the musculoskeletal system. These findings are important as they can aid in distinguishing primary hyperparathyroidism from other forms of metabolic bone diseases and inform physicians regarding disease severity and complications. This pictorial essay compiles bone-imaging features with the aim of improving the diagnosis of skeletal involvement of primary hyperthyroidism.

Figure 1

Subperiosteal resorption of the radial aspect of the middle phalanges of the second and third fingers (white arrows); feathery appearance and early tufts resorption-acroosteolysis (red arrows).

Figure 2

Clavicular subchondral resorption (arrows), widening of the articular space and irregular-feathery articular surface bilaterally.

Figure 3

Additional cases of brown tumors (black arrows) in the ulna, fibula, and humerus. Prominent forearm demineralization with subperiosteal (red arrows), intracortical, and trabecular resorption in the forearm bones and humerus with resultant appearance of coarse internal trabeculation. Pathologic fracture at the humerus brown tumor (yellow arrow) and intracortical resorption with cigar/oval-shaped or tunnel-shaped radiolucency in the cortex (red arrows).

Figure 4

Osteoporosis. Demineralization with predominance of the distal radius and ulna and around the knee, with cortical thinning due to subperiosteal resorption (arrows).

Figure 5

Subchondral resorption of the sacroiliac joints. Coronal and axial CT images show areas of subchondral lucency with irregular articular margin (red arrows), apparent widening of the joint space and surrounding hyperdense sclerosis. Pelvis X-ray symphysis pubis subchondral resorption (white arrow) with widening and also subligamentous resorption of the ischial tuberosities (yellow arrows). (a) Coronal bone CT. (b) Axial bone CT. (c) Pelvis X-ray.

Figure 6

Left humerus brown tumor. X-Ray shows a large, well defined, multiloculated soap-bubbly lucent lesion. MRI T1W1 the lesion is similar to the muscle, on coronal and axial T2WI the lesion is hyperintense (very bright), axial T1WI without contrast the lesion is hypoinetense with prominent thinning of the cortical bone and minimal extension beyond the cortex (red arrows), axial T1WI + C with contrast and fat saturation shows diffuse and peripheral enhancement (white arrow).

Figure 7

Thoracic spine brown tumor. Sagittal CT, sagittal T1WI/T2WI, and axial T1WI/T2WI MRI sequences show an expansible, well-circumscribed lesion in the posterior elements extending within the spinal canal, with severe spinal canal stenosis and compressed spinal cord (white arrow). Areas of low signal on T2W1 from hemosiderin are indicated by the red arrow.

Figure 8

“Salt-and-pepper-skull.” Lateral skull X-ray and axial bone windows CT with salt-and-pepper appearance from trabecular bone resorption depicted as fine areas of lucency mixed with sclerotic radiopaque-denser-dot-like foci.